Potential benefits of zolpidem in disorders of consciousness

Noormandi, Afsaneh; Shahrokhi, Maryam; Khalili, Hossein

doi:10.1080/17512433.2017.1347502

Cited by 22 publications

(3 citation statements)

References 35 publications

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“…Third, we consider the possibility that cortical connectivity, network topology and complexity are true biomarkers of the conscious state, indicating that the level of consciousness of the case examples presented in this paper improved upon exposure to anesthesia. This explanation is supported by previous studies that have shown that a sedative GABAergic drug – zolpidem – can increase arousal in patients with DOC ( Du et al, 2014 ; Machado et al, 2014 ; Noormandi et al, 2017 ; Sripad et al, 2020 ). These observations can be reconciled using the hypothesis that consciousness relies on brain networks which are tuned to criticality, a narrow window between stability and chaos; disorder and order ( Tagliazucchi, 2017 ; Popiel et al, 2020 ; Toker et al, 2022 ).…”

Section: Discussionsupporting

confidence: 78%

Paradoxical markers of conscious levels: Effects of propofol on patients in disorders of consciousness

Maschke

Duclos

Blain-Moraes

2022

Front. Hum. Neurosci.

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Human consciousness is widely understood to be underpinned by rich and diverse functional networks, whose breakdown results in unconsciousness. Candidate neural correlates of anesthetic-induced unconsciousness include: (1) disrupted frontoparietal functional connectivity; (2) disrupted brain network hubs; and (3) reduced spatiotemporal complexity. However, emerging counterexamples have revealed that these markers may appear outside of the state they are associated with, challenging both their inclusion as markers of conscious level, and the theories of consciousness that rely on their evidence. In this study, we present a case series of three individuals in disorders of consciousness (DOC) who exhibit paradoxical brain responses to exposure to anesthesia. High-density electroencephalographic data were recorded from three patients with unresponsive wakefulness syndrome (UWS) while they underwent a protocol of propofol anesthesia with a targeted effect site concentration of 2 μg/ml. Network hubs and directionality of functional connectivity in the alpha frequency band (8–13 Hz), were estimated using the weighted phase lag index (wPLI) and directed phase lag index (dPLI). The spatiotemporal signal complexity was estimated using three types of Lempel-Ziv complexity (LZC). Our results illustrate that exposure to propofol anesthesia can paradoxically result in: (1) increased frontoparietal feedback-dominant connectivity; (2) posterior network hubs; and (3) increased spatiotemporal complexity. The case examples presented in this paper challenge the role of functional connectivity and spatiotemporal complexity in theories of consciousness and for the clinical evaluation of levels of human consciousness.

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Section: Discussionsupporting

confidence: 78%

Paradoxical markers of conscious levels: Effects of propofol on patients in disorders of consciousness

Maschke

Duclos

Blain-Moraes

2022

Front. Hum. Neurosci.

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“…It has been reported that zolpidem has positive effects in several conditions involving decreased level of consciousness, but no benefits of zolpidem were detected in patients with disorders of consciousness. 31 Deep brain stimulation shows therapeutic efficacy in improving the consciousness of patients with disorders of consciousness who show somatosensory evoked potentials and brainstem auditory evoked potentials in at least one side. 32 A previous study 33 reported that transcranial direct current stimulation improved behavior in 43% of patients with a minimally consciousness state.…”

Section: Discussionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation improves consciousness in some patients with disorders of consciousness

et al. 2022

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Objective To investigate the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with disorders of consciousness. Design and Setting We performed a randomized, double-blinded, sham-controlled trial. Participants Patients (N = 40) with disorders of consciousness. Interventions Forty patients with disorders of consciousness (time since onset of the disorder 49.0 ± 24.6 days) were enrolled and randomized to groups receiving either active-rTMS or sham-rTMS. The active-TMS protocol had a frequency of 20 Hz, was delivered over the left dorsolateral prefrontal cortex and had a 100% rest motor threshold. The sham-rTMS protocol was the same as the active protocol without magnetic stimulation over the cortex. Main Outcome Measures Consciousness was evaluated by the Coma Recovery Scale-Revised (CRS-R) before and after the four-week intervention. The ratio of patients that awakened from disorders of consciousness was followed up at discharge. Results Before rTMS sessions, there were no significant differences in consciousness scores between groups. Compared to sham-rTMS (6.25 ± 1.29), patients with disorders of consciousness treated by active rTMS showed strikingly improved consciousness (8.45 ± 3.55). In-depth analysis revealed that only some patients showed obvious increases in consciousness scores induced by active rTMS. Furthermore, rTMS did not significantly enhance the awakening ratio. Conclusions rTMS showed therapeutic efficacy for improving consciousness in some, but not all, patients with disorders of consciousness. It is essential to discern the potential patients whose consciousness can be improved by rTMS.

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“…The use of neurostimulants in the management of patients with DOC is still controversial, and the existing studies are focused more on the role of agents that have a “direct” effect on recovery of consciousness, like Amantadine (a synthetic tricyclic amine with antiviral, antiparkinsonian, and antihyperalgesic activities) or Zolpidem (a benzodiazepine receptor agonist that is used for the treatment of insomnia; see for example [ 67 , 68 , 69 , 70 ]), leaving aside analysis on their potential effects on sleep disorders [ 71 ]. ITB is, instead, mainly used as a central action treatment to improve spasticity, even in patients with DOC, and few uncontrolled studies and case reports have suggested ITB has a potential role in stimulating recovery of consciousness [ 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Sleep Treatments in Disorders of Consciousness: A Systematic Review

et al. 2021

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Sleep disorders are among the main comorbidities in patients with a Disorder of Consciousness (DOC). Given the key role of sleep in neural and cognitive functioning, detecting and treating sleep disorders in DOCs might be an effective therapeutic strategy to boost consciousness recovery and levels of awareness. To date, no systematic reviews have been conducted that explore the effect of sleep treatments in DOCs; thus, we systematically reviewed the existing studies on both pharmacological and non-pharmacological treatments for sleep disorders in DOCs. Among 2267 assessed articles, only 7 were included in the systematic review. The studies focused on two sleep disorder categories (sleep-related breathing disorders and circadian rhythm dysregulation) treated with both pharmacological (Modafinil and Intrathecal Baclofen) and non-pharmacological (positive airway pressure, bright light stimulation, and central thalamic deep brain stimulation) interventions. Although the limited number of studies and their heterogeneity do not allow generalized conclusions, all the studies highlighted the effectiveness of treatments on both sleep disorders and levels of awareness. For this reason, clinical and diagnostic evaluations able to detect sleep disorders in DOC patients should be adopted in the clinical routine for the purpose of intervening promptly with the most appropriate treatment.

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Potential benefits of zolpidem in disorders of consciousness

Cited by 22 publications

References 35 publications

Paradoxical markers of conscious levels: Effects of propofol on patients in disorders of consciousness

Paradoxical markers of conscious levels: Effects of propofol on patients in disorders of consciousness

Repetitive transcranial magnetic stimulation improves consciousness in some patients with disorders of consciousness

Sleep Treatments in Disorders of Consciousness: A Systematic Review

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